This is Going to Hurt: Now a major BBC comedy-drama

As a house officer you think your registrar is unimpeachably correct and clever, like God maybe, or Google, and you try not to bother them under almost any circumstance. As an SHO, they’re your port of call whenever you get stuck and need an answer: the safety net of some wise words just a quick bleep away. And then, before you know it, the registrar is you.

In obs and gynae, it means you’ll frequently be the most senior person in clinic. You’ll lead the ward rounds more often than not. You get to be called Mr Kay rather than Dr – which makes the previous decade of studying feel like a fucking waste of time. You’re expected to teach medical students. You’re expected to perform all but the meatiest of operations. Most crucially, you run the labour ward. There are senior registrars and potentially even consultants available if you hit DEFCON 1, but this is the grade where you’re generally responsible for keeping a dozen labouring mums and babies alive at all times. This one probably needs a caesarean, these two are going to need an instrumental delivery, this one’s haemorrhaging. You become amazing at prioritizing. It’s like you’re living in a constant logic puzzle; the one with the boat, the fox, the chicken and the bag of grain. Except there are a dozen chickens, they’re all delivering triplets and the boat’s made of sugar.

It sounds horrific – and at times it was – but the day I started as a registrar, I had a huge spring in my step. Not since the day I qualified had I felt so optimistic – I was practically shitting confetti. I was suddenly halfway to becoming a consultant, enjoying the Wednesday afternoon of my metaphorical week. Not only was a senior job just a few years away, I could actually picture myself doing it, maybe even doing it well. It felt like everything at work and home was clicking into place, like I’d finally figured out I’d been holding the map upside down all this time. For once my life didn’t seem that depressing compared to non-medic friends. I had a flat, I had a new(er) car and a (more or less) stable relationship. I felt satisfied. Not smug or complacent, but just in marked contrast to the years I’d felt somehow unsatisfied with the way things had been going.

I realized that most of my colleagues weren’t so lucky, especially when it came to their home lives. Mine was largely held together by superhuman levels of tolerance and understanding; most doctors’ relationships crumbled after a year or so – the cracks that they all develop would appear far too early, like some bizarre premature ageing disorder.

Certainly the hours don’t help. After four or five years of intravenous NHS Kool-Aid, staying late, arriving early and filling in for colleagues have become fully formed habits. A widely held belief among non-medics is that there’s some degree of choice involved in coming home at 10 p.m. rather than 8 p.m. But really the only choice is whether you fuck over yourself or your patients. The former is annoying, the latter means that people die – so it’s not really a choice at all. The system runs on skeleton staff and, on all but the quietest shifts, relies on the charity of doctors staying beyond their contracted hours to get things done. It would be against everything you stand for to knowingly compromise patient safety, so you don’t – which means you stay late after almost every shift. Of course, medics aren’t alone in working late – you could say the same of lawyers and bankers – but at least they can become ‘weekend warriors’, letting down their hair and their ancestors in a forty-eight-hour blast of unremitting hedonism. Our weekends were usually spent at work.

But it’s more than just the hours; you’re generally no fun to be around when you get home. You’re exhausted, you’re snappy from a stressful day and you even manage to deny your partner their normal post-work chat of bitching about their colleagues. They know as soon as they start on their workplace quibbles – which presumably don’t involve any near-death experiences, unless they’re a tightrope walker, firefighter or counter staff at a drive-thru Burger King – you’ll reflexively man that old ship One-Up and talk about the horrors of your own day.

Your subconscious ends up making a decision on your behalf. Either you fail to tune out the bad stuff from work and become permanently distracted and haunted at home or you develop a hardened emotional exoskeleton, which apparently isn’t considered an ideal quality in a partner.

A few of my colleagues had kids by this point and lived their lives in constant childcare hell, adding ‘guilt’ to the psychology textbook of emotions that a career in medicine bequeaths you. I don’t have kids, but I could understand what a gut-wrench it was for my colleagues to settle for a goodnight phone call with their children rather than tucking them in and reading them The Gruffalo. Or, more often than not, they’d miss the call altogether because labour ward was in meltdown. A friend who worked in general surgery once couldn’t go along to his own son’s emergency surgery because he was performing non-emergency surgery on someone else’s son and no one could cover for him.

Once I became a registrar, I noticed the interesting paradox that while you become an expert in prioritizing at work, you generally become even worse at prioritizing in real life. But for a while there I felt like the exception who proved the rule – the one guy who had his shit together in some small way, plates all spinning away nicely. Now I just had to make sure none of them smashed . . .

Thursday, 16 August 2007

A horror story. Patient GL, whose genetic make-up appears to be 50 per cent goji berry recipes and 50 per cent Mumsnet posts, has announced she wants to eat her placenta. The midwife and I both pretend not to hear this – firstly because we don’t know what the hospital protocol is, and secondly because it’s completely revolting. GL calls it ‘placentophagia’ to make it sound more official, which doesn’t particularly wash; you can make anything sound official by translating it into the ancient Greek.*

She explains how natural it is among other mammals, which is another somewhat defective argument – we don’t let other mammals do things like run for parliament or drive buses, nor do we normalize other things they do like fucking the furniture or eating their young (or ‘paedophagia’, as she’d presumably call it).

I turn the conversation to the more pressing matter of clapping some forceps on her baby’s head and getting it out. This happens smoothly and baby is fine – and will continue to be until it gets home schooled and taken on all-naked, yurt-based family holidays. A couple of minutes later, I’m delivering the placenta and look up to have the awkward discussion about what GL would like me to do with it. She has a kidney dish in her hands and is shovelling handfuls of blood clots into her mouth.

‘Isn’t this the placenta?’ she asks, blood dribbling out of the corner of her mouth like the disgusting progeny of Dracula and the Cookie Monster. I explain that it’s just some clots I left in a bowl after delivering baby. She turns ashen, then green. Clearly blood isn’t the delicious post-delivery snack she imagines placenta might be. She holds up the kidney dish and vomits into, onto and around it. Sorry, I mean experiences haematemesis.

* ‘Cholelithoproctophilia’ would be shoving gallstones up your arse, but I’ve just made it up. ‘Orbitobelonephilia’ – sticking needles in your eyes. ‘Craniophallic anastamosis’ – dickhead.

Wednesday, 19 September 2007

Email from Head of Administration, Undergraduate Learning Centre:

Dear Adam,

As you know, we are grateful for your commitment to undergraduate teaching. In future when emailing the fourth-year students about teaching sessions, kindly refer to the Undergraduate Learning Centre as the Undergraduate Learning Centre, not the Early Learning Centre.

Tuesday, 2 October 2007

Retrieve my phone from the locker after an unremitting day on labour ward. Seven missed calls from Simon and a bunch of voicemails, all from this morning. I hesitate before pressing play – I know in my heart it’ll be too late already; I’m already half preparing what to say to the coroner. Turns out Simon’s pocket-dialled me, the little bastard.

Wednesday, 24 October 2007

It’s a quiet night on labour ward so I go to my on-call room, lie in bed and piss around on Facebook for a bit. Someone has linked to a bucket list quiz, where you tick off, from a checklist of 100, various things you’ve achieved in your life. Have you visited the Great Wall of China? Ridden an ostrich? Been eaten out by one of Barry Manilow’s security team in a Las Vegas infinity pool? It turns out I’ve done very few things at all. I check my emails, then have a wank.*

Mid-wank, the crash bleep† goes off. Scrub trousers back on, I rush into a delivery room – the mother is pushing and there’s an extremely worrying CTG. Within a minute of walking into the room I have delivered the baby by forceps extraction. Mother and baby both fine, good old me. I can now write my own bucket list and tick off ‘Delivered a baby while still erect’.

* I don’t know what the GMC position is regarding wanking in on-call rooms. An email to them asking for clarification sat unsent in my drafts folder for over a month when I was putting this book together, before I chickened out and deleted it. But we’ve all done it. Basically, make sure your doctor uses the hand gel when he rushes into your room at night.

† For life or death emergencies, you can be summoned by a ‘crash bleep’ – your bleep is granted the power of speech and tells you exactly where to run to, saving valuable seconds.

Thursday, 1 November 2007

I’ve barely started an emergency caesarean when my SHO bursts into theatre to tell me that a patient in another room has a non-reassuring trace and might need an instrumental delivery. My senior registrar is performing some complicated and repulsive emergency gynae op in main theatre and this SHO is a GP trainee on a six-month placement, so it’s my show entirely. I get her to take a photo of the CTG on her phone so I can see how bad it is and attempt to construct some sort of a plan.

By the time she pops back to theatre, I’ve delivered the baby and am starting to sew up the uterus. The trace is much worse than the SHO described, and I have another fifteen minutes of needlework still to go. I put in another stitch to stop the uterus bleeding and ask the scrub nurse to rest a large wet swab over the patient’s open abdomen (leaving her looking like a horrendous Tellytubby) then make my apologies and run off to perform a quick forceps delivery on the other baby. I’ve barely got the tongs off its head when the emergency buzzer blares from the room next door. Another grotty trace, this time needing a ventouse extraction, then management of a post-partum haemorrhage afterwards for good measure.

By the time I get back to theatre to polish off my original caesarean it’s nearly ninety minutes later, and when that one’s done, it’s time to hand over to the morning registrar. I tell him my tale of super-heroism, expecting him to suggest they rename the hospital after me. All I get in reply is a ‘yeah, that happens’, like I’ve mentioned the coffee shop has run out of pains aux raisins.

Monday, 5 November 2007

Patient in antenatal clinic told me she was taking Dorothy every morning because she was feeling stressed. Who’s Dorothy? Some great aunt she was escorting down to the shops as a strange kind of chill-out exercise, like a mental health assistance dog? She informed me Dorothy was the street name for ketamine.*

‘Does it help with the stress?’ I asked – and was genuinely interested in the answer.

* Other terms for ketamine include K, Kit Kat and Special K. Although if she’d told me she was having Special K every morning I may well have missed the reference.

Monday, 12 November 2007

All surgical staff have been summoned to the Early Learning Centre for a lecture on patient safety. Last week a patient had their completely healthy left kidney removed, leaving them only with a completely useless right kidney.

We’re reminded that in the last three years, neurosurgeons in this country have drilled holes in the wrong side of patients’ skulls fifteen times. Fifteen times they couldn’t tell left from right with a Black and Decker at your bonce. Feels like grounds for retiring the ‘it’s hardly brain surgery’ maxim.

The hospital is very keen mistakes like the great kidney snafu aren’t repeated – although it’s slightly too late for this poor guy, whose ashes have presumably just been scattered on the wrong beach.

The upshot is that new hospital protocol states any patient going to theatre must have a large arrow drawn in Sharpie pen on their left or right leg as appropriate. I put my hand up and ask what happens if the patient already has a tattoo of an arrow on the wrong leg. Decent laugh from the lecture theatre and my consultant calls me a fucking clown.

Tuesday, 13 November 2007

I receive an email from Dr Vane, Director of Clinical Governance, advising that if a patient has a tattoo of an arrow on either leg, then it should be covered up with Micropore tape and a new arrow drawn in Sharpie on the correct leg. This will now be included in the policy document, and he thanks me for my valuable contribution.

Tuesday, 8 January 2008

The population is getting fatter faster than a mobility scooter hurtling towards Greggs at closing time. Today our labour ward operating table is being replaced for the second time in as many years, because last month a woman exceeded the weight capacity for the recently acquired ‘obese table’.

I realize it’s a complicated issue, but surely being so big that special equipment has to be ordered in for you would be the first clue that now would be a good time to offload some timber.

The even newer table has enormous wings that flap up from the sides to prevent ‘overspill’, like an industrial version of the dinner table that grandma can extend at Christmas to fit on all the extra vol-au-vents. I reckon you could comfortably rest the Cutty Sark on it – it took ten men, some hydraulic equipment and the best part of two hours to get it into theatre. I presume the next issue will be the table crashing through the floor one day mid-caesarean, killing the entire dermatology department beneath us.

Saturday, 19 January 2008

Today I tipped into full-blown Stockholm Syndrome and decided to go into work on a Saturday off. ‘If you’re having an affair you can just tell me, you know,’ H said.

I performed my first TAH BSO* yesterday and wanted to check the patient was doing OK. Every time my phone buzzed this morning I assumed it was a message from the weekend team to tell me her wound had exploded or I’d punctured her bowel, severed a ureter or let her quietly bleed to death internally. I basically just needed a bit of reassurance to stop myself going insane.

Obviously, she was absolutely fine, and had already been reviewed by my colleague Fred. I immediately felt bad – I’d hate him to think I didn’t trust him to do his job properly (which I don’t), so I nimbly hurried off the ward in order to escape unnoticed. Or not so nimbly – I bumped into him on my way out and had to pretend I was ‘just passing by’, so thought I’d check she was OK.

‘Don’t blame you,’ Fred said, shrugging, and told me his first major op died in hospital. He’d reviewed her obsessively and planned her post-op care meticulously. Then, on the day she was meant to go home, she choked to death on an egg and cress sandwich.

I’m now half considering making my patient nil-by-mouth until discharge, just to be on the safe side. Having ‘just passed by’, I begin the hour-long drive back home and think about what H said earlier. Even if I wanted to have an affair, I honestly think I’d be too tired to unzip my trousers.

* Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the removal of the uterus, cervix, tubes and ovaries. Salpingo-oopherectomy has three ‘o’s in a row, which has to be some kind of record?

Tuesday, 26 February 2008

About to perform a hysteroscopy* on patient FR and as I’m talking through the procedure, she asks, ‘What’s the worst that could happen?’ Patients ask this all the time, and I wish they wouldn’t because obviously the truthful answer is they could die. In her case, as with almost everyone who asks this, the chances of death are infinitesimal, but the question forces my hand into namechecking the Reaper immediately before their operation.

For the past few months, whenever someone has asked, ‘What’s the worst that could happen?’ I’ve replied, ‘The world could explode.’ This generally has the effect of making the patient realize they’re catastrophizing, and breaks the ice a little. Plus, it’s not a lie – one day it will, and doubtless I’ll be working on labour ward when it does.

On this occasion, FR is a fervent believer that the world is going to end in the next five years and invites me to a David Icke† lecture at Brixton Academy next week. I might even go. What’s the worst that could happen?

* Putting a camera inside the uterus. One of the mainstays of gynaecology investigations – principally for abnormal bleeding, but also a traditional procedure if you don’t really know what else to do. The procedure was first performed in 1869, and most units haven’t bought new equipment since.

† Icke is a professional conspiracy theorist and Holocaust denier, who puts on inexorably long, mad speeches. By the time this book is published he’ll no doubt be foreign secretary.

Friday, 29 February 2008

Special occasions tend to call for patients to insert special types of object into their vaginas and recta. Christmas in particular has rewarded me well, with a stuck fairy (‘Do you want it back?’ ‘Yeah, bit of a rinse and she’ll be grand’), a grossly swollen vulva from a mistletoe contact allergy and mild vaginal burns from a patient stuffing a string of lights inside and turning them on (bringing new meaning to the phrase ‘I put the Christmas lights up myself’). This is my first leap year working as a doctor and the Great British public have pulled it out of the bag for me with a very, very specific injury.

Patient JB decided to take advantage of tradition and propose to her boyfriend – going to the expense of buying an engagement ring, the trouble of putting it inside a Kinder Surprise egg and the imagination of inserting it vaginally. She would suggest some finger-work to her partner, he would discover it, retrieve it, and then she would go down on one knee (and, presumably, him). Equal parts unexpected, disgusting and, I suppose, romantic. Unfortunately, he was unable to retrieve it as planned – it had rotated itself lengthwise – and no amount of shoogling from either of them would get this particular goose to lay her golden egg. Remarkably, she was so keen to maintain the surprise she wouldn’t tell him what she’d done or why, but eventually decided this was a hospital matter, so we met in cubicle three. It was a very easy delivery with a pair of sponge-holding forceps.

She hadn’t told me about the contents of the egg either at this point, so there was a moment of confusion for both me and the boyfriend when she asked him to open it. I gave him a pair of latex gloves, sandblasting the very last pico-trace of romance from the scenario. She popped the question and he said yes; presumably out of shock, or fear of what a woman who does that with a Kinder Surprise would do to him if spurned. I wonder where the best man will keep the wedding bands during the ceremony?

Monday, 17 March 2008

I’m unsure who decided that junior doctors have so much spare time on our hands that we should conduct annual audits, but the audit meeting is this week, so I’m sitting reviewing patient notes after my night shift, going through the motions like Lady Chatterley in her marriage to the cockless Sir Clifford. As well as collecting my official audit data on APGAR scores* I have spotted an interesting incidental finding, and have put together some data on that too.

Introduction

2,500 babies are delivered annually on our unit, of which roughly 750 are caesarean sections. The surgeon records hand-written operation notes for every patient, representing the permanent legal record of the procedure.

Methods

I personally reviewed the operative notes of 382 caesarean sections, representing all such procedures performed between January and June 2007.

Results

In 109 cases (28.5 per cent) the surgeon performing the procedure has misspelled ‘caesarean’ as ‘caesarian’.

Conclusion

In almost a third of cases, my colleagues are idiots and can’t spell the name of the only fucking operation they have to remember the name of.

* APGAR scores are the standard measure of how well a newborn baby is doing – they get marks for Appearance, Pulse, Grimace, Activity and Respiration. It was devised by a doctor called Virginia Apgar, which makes me think she chose arbitrary measures just because they fitted with her surname. Like if I decided that the best measures of a baby’s health were Kicking, Applauding and Yawning.

Thursday, 17 April 2008

Sometimes it’s the little things that make a difference on labour ward. The touch on your arm and a muttered thank you from the mum too exhausted by her labour to speak. The Diet Coke an SHO buys you because you look so knackered. The reassuring nod from your consultant that says ‘you’ve got this’. And sometimes it’s the really massive things that make a difference – like a patient’s husband taking me to one side after an emergency caesarean to thank me, mentioning that he’s head of marketing for the UK operations of a large champagne house and taking my name so he can send me ‘a little something’. I spend a week dreaming of splashing about in a gigantic champagne coupe filled to the brim with prohibitively expensive fizz, like an ostentatious burlesque act.

Today a package arrived for me at work – and I don’t mean to be ungrateful, but seriously? A branded baseball cap and key ring?

Monday, 21 April 2008

Performing an elective caesarean section, assisted by a hungover medical student. With the possible exception of diathermy,* which smells deliciously like frying bacon, the sights and smells of labour ward theatres aren’t great for the morning after. Take a look at the ingredients: there’s over half a litre of blood spilled, plus a tidal wave of amniotic fluid when you cut through the uterus, the baby’s covered in more gunk than you’d find in the plughole of a cattery and the placenta always smells like stale semen – none of which you really want to be faced with when your burps still taste of Jägerbomb and you’re sweating rogan josh through your eyeballs. Baby delivered, and just as I was sewing up the uterus, the student fainted, face-planting right into the open abdomen. ‘We should probably give the patient some antibiotics,’ the anaesthetist suggested.

* Diathermy is essentially a soldering iron – it heats up the area you touch it on and stops small blood vessels from bleeding by sealing them off. It is important not to clean the skin with alcohol-based antiseptic before the operation, otherwise diathermy sparks can set the patient on fire.

Tuesday, 13 May 2008

At a pub quiz with Ron and a few others and one of the questions is ‘How many bones are there in the human body?’ I’m out by about sixty, to the general outrage of my teammates. I try to explain myself: it’s not something you’d ever be taught; there’s no clinical situation where you’d actually need to know this; it’s an irrelevance; I wouldn’t expect Ron to be able to say how many types of tax there are . . . But it’s too late. I can see from the look on everyone’s horrified faces that they’re trying to think back to all the times they’ve asked for medical advice from a doctor who doesn’t even know how many bones there are. Three other teams got the correct answer.*

* It’s 206.

Monday, 2 June 2008

Antenatal clinic. Called in by a midwife to review her patient – a low-risk primip* at thirty-two weeks, here for a routine check-up. The midwife was unable to pick up baby’s heart with the Sonicaid† so wants me to pop in. This happens fairly often, and 99 per cent of the time all is well. I tend to grab a portable ultrasound machine, wheel it in like a hostess trolley, quickly show the parents their baby’s heart on a monitor and then wheel it all back out again, grinning like a gameshow compère. When they’ve had the agony of listening in vain for baby’s heart swoosh-swooshing, all they want is some unequivocal evidence on a screen.

This is clearly the 1 per cent though, and I can tell as soon as I enter the room. This midwife really knows what she’s doing, and she looks ashen. The patient is a GP, married to an ophthalmology registrar, so we’re in the rare situation where everyone in the room already knows there’s something seriously wrong. I can’t even manage my ‘I’m sure everything’s fine’ speech before I put the ultrasound probe on.

To make matters worse, I have to call a consultant in to confirm fetal death for the notes, even though both parents know I’ve been looking at the four unmoving chambers of their baby’s heart on the screen. She’s being rational, practical, collected – suddenly in work mode, her emotional shields up as high as mine. He’s in bits. ‘You shouldn’t have to bury your child.’

* Primip (short for primiparous), meaning first pregnancy. Multip (multiparous) for subsequent pregnancies.

† Sonicaid is the handheld device that you listen for babies’ hearts with.

Thursday, 5 June 2008

The rota has been flinging me around the hospital seemingly at random – from antenatal clinic to gynae theatre to infertility clinic to labour ward to colposcopy to scanning – so everyone feels like a stranger at the moment. I’ve all but given up hope of seeing someone I recognize, unless they’re handing me a latte in Costa.

It’s especially rare to see the same patient more than once, but on my afternoon round of labour ward I see the GP I’d diagnosed with an intra-uterine death in clinic earlier this week. She’s now in labour, having been induced.* She and her husband seem oddly pleased to see me – a familiar face, someone who doesn’t need an explanation and is already tuned in to what’s happening, can be of some comfort on such an awful, scary day.

What the hell can you say? It feels like a woeful gap in our training that no one’s ever told us about talking to grieving couples. Will I make it better or worse if I talk positively about ‘next time’? I want to give them hope, but feel like I shouldn’t say it. It’s an extreme version of ‘there are plenty more fish in the sea’ after a break-up, as if babies are totally interchangeable, just so long as you have one. Do I say how sad I feel for them? Is that making it all about me, giving them yet another person’s feelings to consider? They’ll have plenty of their own family members throwing themselves at their feet in misery; they certainly don’t need this from me. How about a hug? Too much? Not enough?

Stick to what you know. I just talk practically about what will happen over the next few hours. They have a thousand questions, which I answer as best I can. This is clearly their way of coping for now, medicalizing it.

I pop back every hour or so to see how they’re doing. It goes past 8 p.m., and I decide to stay on labour ward until they’ve delivered. H is expecting me back home any minute but I lie in a text that there’s been an emergency and I need to stay. I don’t know why I can’t just tell the truth. I lie to the patient too when she asks why I’m still here gone 11 p.m. ‘I’m covering for someone,’ I say. It does feel like my presence, if not my conversational skills, are helping them a bit.

Delivery happens shortly after midnight, and I take blood samples from mum and talk through all the possible tests we can do to find a cause for the stillbirth. They opt for everything, which is understandable, but this means I have to take skin and muscle samples from baby, the worst thing for me in this whole job. It used to upset me so much when I first started that I’d practically have to look away while I did the necessary. Now, slightly more desensitized to a thing you can never quite believe you’ll ever become desensitized to, I can look. I just find it heartbreakingly sad cutting into a dead baby. We expect them to look beautiful, perfect, unspoiled; often they don’t. He’s been dead a couple of weeks, looking at him – he’s macerated, skin peeling, head softened, almost burnt-looking. ‘I’m sorry,’ I say to him as I take the samples I need. ‘There we go, all done now.’

I dress him again, look up to a God I don’t believe in and say, ‘Look after him.’

* It’s a terrible cruelty that if a baby dies in utero, the safest place to deliver is on labour ward, surrounded by dozens of mothers and babies.

Tuesday, 10 June 2008

Stopped by the police in Holland Park. ‘Did you know you just ran a red light there, sir?’ I honestly didn’t. I’d been driving home on autopilot, utterly exhausted after a relentless night shift that included five caesarean sections. Hopefully I was paying more attention in theatre than on the road.

I explain to my frontline brothers that I’ve just come off labour ward after thirteen hours. They give not a single shit, a £60 fine and three penalty points.

Wednesday, 18 June 2008

I’m no stranger to speaking in code in front of patients. Just a stray word here or there can be the difference between a patient drawing up ambitious plans to build a shrine in your honour and hysterically accusing you of plotting their demise. So we’ve got our equivalent of spelling out W-A-L-K-I-E-S in front of the dog or T-R-I-A-L S-E-P-A-R-A-T-I-O-N to fox an eavesdropping five-year-old.* But it’s not just patients who need to be kept in the dark from time to time. On this job I’ve also had to develop a code so Miss Bagshot can’t understand me, just to survive her interminable consultant ward rounds. When I need a caffeine hit I tell the house officer to ‘review Mrs Buckstar’, and he pops down to Starbucks for me. Three months in and she hasn’t broken this seemingly uncrackable cipher. Either that or she’s turned on by my coffee breath.

* There are three grades of code. Firstly, there’s the formal Latin and Greek terms for conditions. So, we say ‘dyspnoea’ rather than ‘shortness of breath’ and ‘epididymo-orchitis’ rather than ‘gammy cock and balls’. Secondly, there’s using a layer of euphemism. Instead of suggesting syphilis, we ask to ‘check the VDRL’, which is the lab test involved; rather than saying HIV, we can talk about ‘CD4 deficiency’, referring to the underlying immune problem. Thirdly, and much more fun, are the completely made-up ones that have entered medical vocab in the last couple of decades. They generally sound credible and scientific, and allow you to be frank in front of the patient without them realizing.

A few of my favourites are:

Chronic glucose poisoning – Obesity.

Incarceritis – Onset of symptoms immediately following arrest.

Q sign – Tongue hanging out of side of mouth, in the shape of a Q. Prognostically-speaking, a very bad sign, though not as bad as the Dotted Q sign, where there’s a fly on the tongue.

Status dramaticus – Medically well but over-emotional.

Therapeutic phlebotomy – Gets better after a blood test.

Transferred to the fifteenth floor – Dead. (NB The number should be one higher than number of floors in the hospital.)

Friday, 20 June 2008

I’m teaching the SHO a method of skin closure using staples that I think gives as good a cosmetic result as sutures in a quarter of the time.* He does an excellent job using this technique, but I count at the end that he has used ten staples. I explain it’s bad luck to close with an even number of staples and ask him to put in an extra one in the middle of the incision. I’m not superstitious – I’ll happily limbo under ladders or live in a flat full of open umbrellas – but it’s something I was taught years ago and have passed on to juniors ever since. Science may trump the supernatural, but once someone tells you an operative technique is bad luck, it’s probably better to be safe than sorry. No one wants to be bleeped in the middle of the night because a plateful of intestines have made a surprise appearance out the front of a patient’s abdomen.

Fully briefed on how to fend off this imminent crisis from the spirit world, my SHO takes the staple gun to insert the final talisman – and accidentally drives a staple deep into the pulp of my finger.

* Materials and technique in skin closure vary surgeon by surgeon. The staplers, and indeed staples, used are a barely modified version of the kind you’d buy at Rymans.

Thursday, 3 July 2008

Patient TH has been telling me for two days now that her breast pump is bugged. I’ve had to promise her that we’ll have it investigated because when I tried to reassure her initially, she started screaming that I was in with the Russians as well. I made my fairly uncontroversial diagnosis of puerperal psychosis,* but failed to persuade the psychiatrists that she was sufficiently unhinged to justify a review. They weren’t convinced she was at risk of endangering herself or her baby. It felt rather like an orthopaedic team refusing to see a patient who had a broken leg on the basis they weren’t due to participate in the New York Marathon.

Phone call from A&E today – patient TH is currently being reviewed by psychiatry having been brought in by the police. The Starbucks downstairs had phoned 999 after she rocked up, stripped off all her clothes, stood on a table and started singing ‘Holding out for a Hero’. Useful to know where the psychiatrists set the bar.

* Puerperal psychosis is the nuclear version of postnatal depression – severe psychiatric symptoms in the days after giving birth, occurring in roughly 1 in 1,000 women.

Friday, 4 July 2008

Patient NS presents to urogynae clinic for replacement of a lost ring pessary.* She asks if there are options other than the ring type, because they have a bit of ‘baggage’ for her now. She’s fifty-eight years old, and a few weeks ago was dancing at her niece’s wedding, wearing ‘less than substantial’ underwear beneath her dress. Her vigorous Macarena-ing caused the pessary to dislodge and plunge straight down onto the dance floor then happily roll across it, eventually coming to a halt at the feet of the best man.

‘What’s this?’ he bellowed, holding it aloft. ‘Has someone’s pram lost a wheel? Oh! Is it some kid’s teething ring?’ The patient departed the dance floor and the wedding before she found out whether or not it got thrust into some poor toddler’s mouth. I offer her a shelf pessary† and a sympathetic smile.

* A ring pessary is a doughnut of stiff plastic that goes up your vagina and keeps your internal organs, well, internal. Pessaries have existed as long as pelvic organ prolapse, which is to say a couple of years after the first woman gave birth. Historically, a popular type of pessary was the potato – shove it up there and everything stays put nicely. Horrifyingly, the warm and moist environment is an ideal sprouting environment for root vegetables, so they would have to trim the green shoots as soon as they started bristling against their underwear.

† A shelf pessary looks like one of those hooks you put on the back of your bedroom door to hang your dressing gown on. You get it in or out by holding the hook bit, and the plate section keeps your uterus out of the public eye.

Monday, 7 July 2008

Crash call to a labour ward room. The husband was dicking around on a birthing ball and fell off, cracking his skull on the ground.

Tuesday, 8 July 2008

The phrase ‘rollercoaster of emotions’ gets a lot of airtime in obs and gynae but I’ve never seen the big dipper hurtle round its loop quite as fast as today. Called to the Early Pregnancy Unit by one of the SHOs to confirm a miscarriage at eight weeks – he’s new to scanning and wants a second pair of eyes. I remember that feeling only too well and scamper over. He’s managed the couple’s expectations very well, and clearly made them aware it doesn’t look good – they’re sad and silent as I walk in.

What he hasn’t done very well is the ultrasound. He may as well have been scanning the back of his hand or a packet of Quavers. Not only is the baby fine, but so is the other baby that he hadn’t spotted. Not sure I’ve ever had to break good news before.*

* Twins occur in 1 in 80 spontaneous pregnancies – they’re more common in IVF because you generally implant a couple of embryos a pop. Chances of triplets are 1 in 80 squared (1:6,400), quads are 1 in 80 cubed (1:512,000) and so on. Almost every complication of pregnancy is more likely the more babies you’re carrying – anything higher-order than twins is generally a bit of an obstetric catastrophe. Although I once had a patient with quads, and I seem to remember she ended up getting free nappies, clothes, baby food and a people carrier by way of sponsorship.

Thursday, 10 July 2008

Next week me and H head off for a fortnight in Mauritius, to celebrate five years together. I’m excited about a bleep-free existence and hopeful I haven’t forgotten how to have a relationship that isn’t conducted over hurried breakfasts and apologetic texts.

The problem with being in a bubble is that it only takes one prick to burst it. It comes in the form of an email from medical staffing, letting me know I now need to work the middle weekend. None of my colleagues can swap with me and I don’t know how to deliver babies over Skype, so I go back to medical staffing to explain my predicament. I have the kind of sinking feeling you’d have going to the headmaster’s office to deny you stole liquorice from the tuck shop, with teeth stained carbon-black.

I know colleagues who’ve had to cut honeymoons short and miss family funerals, so the odds were never great for them bending the rota for a holiday. They refuse to organize a locum – their best suggestion is that I pop back to England for a bit. I don’t think I’ll get away with breaking this one to H by text message.